Family physician consultation patterns indicate high risk for early‐onset anorexia nervosa

Lask, Bryan; Bryant‐Waugh, Rachel; Wright, Fiona; Campbell, Mari; Willoughby, Kate; Waller, Glenn

doi:10.1002/eat.20163

Cited by 42 publications

(36 citation statements)

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“…50-90% in BN) (Johnson et al, 2001;Whitehouse et al, 1992), and that practitioners may be more likely to detect AN than BN or atypical eating disorders (Whitehouse et al, 1992); to detect eating disorders in females than in males (Currin et al, 2007); and to detect eating disorders if they themselves are female (Hugo et al, 2000). Related research has found that individuals with an identified eating disorder may attend more primary care appointments in the 5 years prior to their diagnosis than control patients over the same time frame (Lask et al, 2005;Ogg et al, 1997), suggesting that opportunities for earlier diagnosis and/or intervention may exist.…”

Section: Introductionmentioning

confidence: 97%

Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires

Allen

Fursland

Watson

et al. 2011

Journal of Mental Health

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Section: Introductionmentioning

confidence: 97%

Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires

Allen

Fursland

Watson

et al. 2011

Journal of Mental Health

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“…75 Little is known about the service use of people with AN prior to entering treatment, but there is some evidence on elevated service use up to 5 years prior to diagnosis. 21,22 For our higher cost estimate, we draw on baseline information from the three trials analysed in Chapter 11 to estimate a plausible range of primary care costs (GP, nurse, dietitian) incurred prior to an inpatient admission or outpatient treatment. When treatment is provided exclusively in primary care, we assume that each person is in contact with their GP three times per year (NICE 2004 ED guidance 162 ).…”

Section: Primary Care Costsmentioning

confidence: 99%

“…21 A single consultation about eating or weight/shape concerns strongly predicts the subsequent emergence of AN. 22 Although GPs exclusively treat 20% of cases with AN, 23 they are often not confident at managing AN, 24 and there is usually a considerable delay between a diagnosis being made in primary care and the point when more specialist help becomes available. 25 Many parts of the UK lack NHS provision of specialist services for AN.…”

Section: Introductionmentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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“…Even just one discussion about eating behaviour, weight or shape concerns during a consultation with a young person in a primary care setting can be a strong predictor of the subsequent development of an ED 39. Indeed, in the 5 years preceding their ED diagnosis, girls with early onset AN have been observed to visit their GP more frequently to discuss issues involving eating, weight and shape, compared with girls with other mental health problems and healthy controls 37.…”

Section: Eds—the Schoolspace Studymentioning

confidence: 99%

Listen and learn: engaging young people, their families and schools in early intervention research

Connor

2017

Med Humanities

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Recent policy guidelines highlight the importance of increasing the identification of young people at risk of developing mental health problems in order to prevent their transition to long-term problems, avoid crisis and remove the need for care through specialist mental health services or hospitalisation. Early awareness of the often insidious behavioural and cognitive changes associated with deteriorating mental well-being, however, is difficult, but it is vital if young people, their families and those who work with them are to be fully equipped with the skills to aid early help-seeking. Our early intervention research continues to highlight the necessity of engaging with and listening to the voices of young people, families and those who work with children and young people, in developing greater understanding of why some young people may be more at risk in terms of their mental health, and to provide children and young people with the best mental health support we can. Collaborative working with young people, their families and those who work with them has been an essential dimension of our youth mental health research in Birmingham, UK, enabling us to listen to the personal narratives of those with lived experience and to work alongside them. This paper highlights some of our key studies and how we have endeavoured to make intra-agency working successful at each stage of the research process through increasing use of digital and youth-informed resources to engage young people: a methodology which continues to inform, guide and develop our early intervention research and implementation.

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Family physician consultation patterns indicate high risk for early‐onset anorexia nervosa

Abstract: A single consultation about eating behaviour or weight and shape concerns is a strong predictor of the subsequent emergence of anorexia nervosa.

Cited by 42 publications

References 13 publications

Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires

Eating disorder diagnoses in general practice settings: Comparison with structured clinical interview and self-report questionnaires

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Listen and learn: engaging young people, their families and schools in early intervention research

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